Even as an experimental vaccine is being deployed to limit the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC), provision of the clinical care necessary for improving survival among infected patients must also be prioritised. During the early part of the 2013–16 west African epidemic when intravenous fluids were not readily available, the nearly four–fold difference in mortality between patients treated in high–income countries (18·5%) compared with those managed in west Africa (70·8%) suggests that aggressive hydration, among other measures, could improve outcomes.